Tots Affected by Parents' Moods, Violence

by Michael Smith Michael Smith North American Correspondent, MedPage Today
February 05, 2013

Action Points

This study was designed to examine the association between intimate partner violence and depressive symptoms occurring among parents within the first 3 years of their child's life, and the development of subsequent psychological conditions in the child.

The study found that children of parents reporting both intimate partner violence and depressive symptoms were more likely to have a diagnosis of attention-deficit/hyperactivity disorder, and children whose parents reported depressive symptoms were more likely to have been prescribed psychotropic medication.

Even in preschool children, exposure to violence between their parents and to parental depression is associated with an increased risk of psychological issues, researchers reported.

In a prospective observational study, children exposed to both parental violence and depression before the age of 3 were significantly more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) before they were 6, according to Nerissa Bauer, MD, and colleagues at the Indiana University School of Medicine in Indianapolis.

And those whose parents reported depressive symptoms were more likely to be prescribed psychotropic medication, Bauer and colleagues reported online in JAMA Pediatrics.

Exposure to "intimate partner violence" and parental depression have been linked to behavioral problems and poor school functioning, the researchers noted; however, most such studies focused on high-risk populations and on school-age children.

To examine the issue among younger children, they turned to four Indiana pediatric clinics that used the same computerized clinical decision support system.

They looked at children who got care from Nov. 1, 2004, to June 7, 2012, including only those who had at least two visits – one between birth and 36 months to classify exposures to parental violence and depressive symptoms, and a second between 37 and 72 months to classify outcomes, such as diagnosis of ADHD or anxiety.

Based on clinic billing data, rates of mental health disorders found when the children were between ages 3 and 6 varied by diagnosis, including 3.3% with ADHD, 8.7% with disruptive behavior disorder, 0.7% with anxiety, 0.4% with depression, 0.3% with sleep problems, and 1,7% with adjustment disorder.

Pharmacy claims data showed that 2% of the children had been prescribed a psychotropic drug, mainly for ADHD, Bauer and colleagues reported.

Statistical analysis showed that only the prevalence of ADHD after the age of 3 was associated with parent-reported depressive symptoms -- 4.5% compared with 2.8% among those whose parents did not report such symptoms (P≤0.03).

In addition, those whose parents reported depressive symptoms had a higher likelihood of being given psychotropic medication: 2.9% were prescribed such medication, compared with 1.6% for those with no parent-reported depressive symptoms (P≤0.03).

Children whose parents reported both violence and depression were more likely to be diagnosed with ADHD (AOR 4.0, 95% CI 1.5 to 10.9).

Children whose parents reported depressive symptoms were more likely to have been prescribed psychotropic drugs (AOR 1.9, 95% CI 1.0 to 3.4).

Bauer and colleagues cautioned that the study was observational, so that unmeasured confounding factors – such as concurrent child abuse – might have affected the results.

Nonetheless, they concluded, the results suggest that pediatricians can "play a critical role" in active surveillance of families with parental violence and depression, which would allow them to provide early interventions and prevent poor outcomes.

The study had support from the Agency for Healthcare Research and Quality and the National Library of Medicine. The journal said the authors made no financial disclosures.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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